Understanding Symbolic Breakdown in Adolescent Obsessionality

Opening Vignette – “It’s Fine.”

He’s fifteen.

He doesn’t make eye contact when he walks in.

He hasn’t made eye contact in four sessions.

He always starts with the same phrase: “It’s fine. I’m just tired.”

His rituals are quiet—checking, tapping, repeating phrases in his head.

He used to explain them. Not anymore.

Today, he crosses his arms and stares at the window.

I ask, “Do you think the thoughts feel worse this week?”

He shrugs.

“I dunno. It’s all the same.”

But it’s not the same.

He’s slipping into something quieter, heavier.

The room feels thinner. The connection less real.

This isn’t avoidance.

This isn’t resistance.

This is symbolic collapse.

2. What Is Symbolic Collapse?

Symbolic collapse is the moment when a young person can no longer translate inner experience into representational form.

They may still speak. They may still act.

But they are no longer expressing—they are discharging.

Words and rituals remain, but meaning drains out.

Think of symbolic life as a bridge between the inner and outer world. When that bridge holds, a child can say:

“I feel like my thoughts are too much. I wash to make them stop.”

But when collapse sets in, the bridge gives way:

“I just have to wash. I don’t know why. I just do.”

The psychic signal doesn’t disappear.

It’s still coming through.

But it’s coming through as noise, not music—raw data without form.

CAMHS Case Illustration: The Hand-Washer Who Used to Explain

A 14-year-old boy with contamination OCD.

In earlier sessions, he described his rituals vividly:

“If I don’t wash, the image of my sister getting sick gets stuck in my head.”

This was painful—but symbolically alive.

Later, something shifts.

He enters, looks away, mumbles:

“I just wash. I dunno.”

No metaphor. No storyline. Just compulsion.

This isn’t avoidance or defiance.

It’s symbolic collapse.

His mind can no longer formulate the fear as a thought—it must be acted, evacuated, ritualised.

The washing now is the fear.

Not a representation of the fear.

The fear, directly encoded into behaviour.

Three Layers: From Symbol to Collapse

1. Symbol –

“I’m scared something bad will happen, and washing makes it feel safer.”

• The ritual represents the fear and tries to manage it.

• There’s still narrative, even if it’s irrational.

• The therapist can work with the meaning.

2. Symbolic Equation –

“If I don’t wash, it will happen.”

• The boundary between thought and reality blurs.

• The inner experience fuses with the external world.

• Washing is no longer about a fear—it’s about preventing an outcome that feels already true.

3. Symbolic Collapse –

“I just have to.”

• There is no representational layer at all.

• No capacity to link affect to idea.

• Only the act remains—repetitive, unexplained, unreflective.

Another CAMHS Parallel: School Refusal

• In symbolic mode:

“I feel panicky at school. It’s like everyone’s watching me.”

• In symbolic equation:

“If I go to school, I’ll have a panic attack.”

• In collapse:

“I’m not going.”

The panic is no longer about something—it just is.

It has no image, no words, no representational handle.

Symbolic collapse doesn’t mean the symptom disappears.

It means the symptom stops communicating.

It becomes a sealed system—affect circling affect, without escape into symbol.

Why This Matters

In symbolic therapy, we’re not just treating symptoms—we’re watching for the state of the symbolising function itself.

When it breaks down:

• Psychoeducation lands flat.

• ERP gets rejected or robotically performed.

• Questions about “what does this mean?” get met with “I dunno,” “nothing,” or silence.

That’s not resistance.

That’s the signal you’re working with a mind that’s fallen out of representation—and into pure psychic discharge.

3. Segal and the Collapse of the Symbol

Hanna Segal taught us that when symbolisation fails, the mind substitutes something else: a symbolic equation.

In a symbol:

“I feel dirty.”

In a symbolic equation:

“I am dirty.”

There’s no gap between the inner state and the thing.

It’s fused. And when it’s fused, there’s no room for reflection.

In adolescent OCD, we often see:

• Repetition without narrative

• Shame without storyline

• Behaviour without symbolic container

We’re not just working with compulsions.

We’re working with the collapse of meaning itself.

4. What It Feels Like in the Room

You’ll feel it before you can explain it.

That’s often the only clue.

• You feel blank or oddly bored

• You want to rescue the session

• You hear yourself becoming more “interventionist”

• You doubt your usefulness

• You feel like nothing can reach them

That’s not a failure.

That’s your symbolic barometer.

The collapse is in the room—and you’re being asked to hold it.

5. What Do We Mean by Symbolic Therapy?

“By symbolic therapy, I mean a therapeutic stance that prioritises the young person’s ability to use internal and external symbols to represent emotional experience.

This doesn’t mean using metaphors or art materials—it means recognising when psychic life is alive enough to be translated into thought, word, or symbol.

Not all therapy is symbolic, even if it uses words.”

Let’s bring that to life with a few grounded examples:

Example 1 – The Contamination Ritual

• Non-symbolic approach:

Therapist: “What are the germs doing? What are you afraid will happen?”

Young person: “They’ll get in and kill me.”

Therapist responds with psychoeducation and ERP.

• Symbolic therapy stance:

Therapist notices the emotional tone has changed—flatter, distant.

“I wonder if this routine is helping something inside stay together, even if you don’t know why yet.”

The therapist waits with the absence of meaning, rather than filling it.

Example 2 – The Silenced Adolescent

• Non-symbolic intervention:

Therapist: “You haven’t spoken much today. Should we try a worksheet?”

• Symbolic intervention:

Therapist: “It feels harder to talk today. I wonder if even trying to think about it feels like too much.”

Containment replaces demand.

Example 3 – Drawing in the Early Sessions

• Misread as symbolic therapy:

Therapist: “Let’s draw how you feel.”

Child draws a monster. Therapist says: “So you’re angry?”

• Actual symbolic therapy:

Therapist notices the monster has no mouth.

“It looks like this one doesn’t speak. Maybe it’s too much to say anything at all right now.”

The drawing becomes a container—not a prompt.

6. How We Respond

What not to do:

• Don’t demand content

• Don’t force metaphor

• Don’t panic

What to do:

• Notice the atmosphere

• Name the feeling of disconnection

• Contain the collapse without rushing to fix it

Therapist might say:

“It feels like something’s disappeared today—even the part that used to explain things.”

“Maybe this isn’t about what’s happening. Maybe it’s about something that can’t be said yet.”

These are invitations—not interpretations.

7. A Case Illustration

A 13-year-old with intrusive thoughts about stabbing his teacher.

In early sessions, he tells the story with shame, tears, and careful ritual logic.

Session 8: he walks in, drops his bag, and stares out the window.

I ask, “Is it the same thought today?”

He shrugs:

“I dunno. Doesn’t matter. It’s just there. It always is.”

I feel a sinking in my stomach.

This isn’t resignation. It’s psychic retreat.

I say:

“I wonder if even saying it out loud doesn’t work like it used to. Like it’s not helping anymore.”

His eyes fill with tears. He doesn’t speak.

But he stays.

And something symbolic is beginning to stir again—not in explanation, but in presence.

8. What’s at Stake

If we miss symbolic collapse:

• We over-interpret and under-contain

• We push therapy toward content when the psyche has no container

• We respond to the symptom and ignore the psychic structure beneath it

Sometimes, talking is the defence.

Sometimes, silence is the wound.

Our job is to know the difference.

9. Closing

So ask yourself:

“Can this young person still represent their experience with words, play, metaphor, image, or feeling?”

If the answer is no—your job is not to fix the ritual.

Your job is to sit beside what cannot yet be symbolised—and wait for it to return.

That’s symbolic therapy.

That’s our task.